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General NPI Number Information
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NPI Number | 1538056726
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Entity Type | Individual
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Provider Name | JAMIE L CRISTOBAL
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Gender | Female
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1907 STARKS CIR
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City | LAFAYETTE
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State | IN
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Zip | 47909-7380
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Country | US
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Telephone | 850-866-5532
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Fax |
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Provider Business Mailing Address
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Address Line | 120 BELLINGHAM AVE
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City | LAFAYETTE
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State | IN
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Zip | 47909-6742
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Country | US
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Telephone | 765-421-0164
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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